[Autokeratoplasty in perforation of the ectatic leukoma of the only functionally perspective eye]. / Autokeratoplastika pri perforatsii éktazirovannogo bel'ma edinstvennogo glaza.

Treatment and rehabilitation of patients with destructive lesions of the cornea is a serious problem for ophthalmologists due to severity of the outcome of the disease - the formation of leukomas with a persistent decrease in vision, or even a complete loss of visual functions. The article presents a clinical case of a patient with posttraumatic ectaticized leukoma of the functionally promising eye, which course was complicated by perforation. The authors, in the absence of the donor cornea, faced a complex clinical task - the risk of functional and anatomical death of the single eyeball in the absence of adequate care for the patient. After enucleation of the subatrophic blind right eye, we took a corneal specimen with a scleral rim of 12 mm trepan. To collect the material, we used an original method of introducing viscoelastic into the vitreal cavity of the hypotonic enucleated eyeball through the intersected optic nerve. This allowed to create the normotony of the enucleated eyeball and perform trepanation of the corneoscleral disc. Trepanation of the sharply ectatic cornea of the left eye was performed after paracentesis and massage of the dome of ectatic cornea with a spatula, which led to the 'subsidence' of the hyperinflated tissue. The corneoscleral disc was fixated with interrupted suture with a 9-0 thread. The postoperative period proceeded smoothly. The autograft has taken with active vascularization. For optical rehabilitation, the patient is scheduled to undergo a keratoprosthetic operation in a planned manner.

[Initial combination therapy for primary open-angle glaucoma]. / 'Startovaia' kombinirovannaia terapiia pervichnoi otkrytougol'noi glaukomy.

PURPOSE: To study the efficacy and safety of initial combination therapy in patients with primary open-angle glaucoma (POAG). MATERIAL AND METHODS: The study included 111 patients (161 eyes) with stages II-III b-c of POAG aged 46 to 89 years (mean age 70.8±8.5 years). In the test group, therapy began with a fixed combination of prostaglandin (PG) (latanoprost) and beta-blocker (BB) (timolol). In patients of the control group, POAG therapy began with administration of the analogue of prostaglandin (latanoprost). When the target IOP was not achieved, a second drug was added to the treatment - instillations of 0.5% solution of timolol maleate 2 times a day. RESULTS: In patients of the test group the treatment started with a combination of BB + PG, the target IOP in the 'worst' eyes was achieved in 33 cases (64%) in 1.5±0.6 visits, and in the 'best' eyes - in 17 cases (81%), in 1.2±0.4 visits. In the control group with a 'step-by-step' selection of antihypertensive therapy, the target IOP in the 'worst' eyes was achieved in 35 cases (59%), in 2.5±0.7 visits, and in the 'best' eyes - in 22 cases (76%), in 2.2±0.5 visits (p<0.05). In both study groups, there were no cases of drug withdrawal attributed to their side effects. Patients noted conjunctival hyperemia in 5% (4 eyes) and 7% (6 eyes) of cases in the test group and the control group, respectively (p>0.05). Hyperemia decreased significantly in 2 weeks of latanoprost administration or fixed combination and did not cause withdrawal. CONCLUSION: Initial combination therapy is possible in patients with newly diagnosed POAG in some clinical situations, namely in stages II-III POAG with high IOP, unavailability of regular observation of patients for various social and economic reasons, absence of somatic and local contraindications to individual components of the combined treatment, etc.

[Ocular hypotensive effect of systemic beta-blockers in patients with primary glaucoma and arterial hypertension]. / Oftal'mogipotenzivnyĭ éffekt sistemnogo primeneniia beta-blokatorov pri pervichnoĭ glaukome i arterial'noĭ gipertenzii.

AIM: to evaluate the ocular hypotensive efficacy of systemic beta-blockers in primary glaucoma patients suffering from arterial hypertension (AH). MATERIAL AND METHODS: The study included 29 patients with POAG (58 eyes) aged from 47 to 83 years. Patients with stage I-III POAG received instillations of prostaglandin analogs and carbonic anhydrase inhibitors. All POAG patients also suffered from arterial hypertension and were prescribed selective beta-blockers (metoprolol, bisoprolol, or nebivalol) as monotherapy or as part of combination therapy (if the target arterial pressure had not been achieved under the initial treatment). After the start of oral beta-blockers therapy, the patients were re-examined at 2 and 4 weeks, 3 months, 6 months, and 1 year. RESULTS: A clinically significant reduction of IOP in the most seriously affected eye - by 3.3 mmHg (p<0.05), or 14% - occurred four weeks after the start of selective beta-blockers. Over three months of combination therapy, IOP in the 'worst' eye decreased by 4.4 mmHg (18.5%). At 1 year, IOP in the 'worst' eye was 6.2 mmHg (26%) lower than at baseline (p<0.05). CONCLUSION: Aged and senile patients with primary glaucoma usually suffer from polypathy (on average, they have 6.3±0.6 concurrent somatic diseases). To reduce the risk of polypharmacy and the frequency of side effects in the treatment of POAG and AH patients, it is advised that the treatment includes oral selective beta-blockers able to provide target levels of arterial pressure and IOP. In this study, oral beta-blockers in POAG and AH patients enabled IOP reduction as great as 18.5%-26% of baseline values over a 1-year follow-up period.

[Reasons for intraocular pressure to resist hypotensive therapy in glaucoma patients]. / Prichiny rezistentnosti VGD k gipotenzivnoi terapii u bol'nykh s glaukomoi.

AIM: To study the reasons of intraocular pressure (IOP) resistance to therapy in patients with glaucoma. MATERIAL AND METHODS: During the period 2011-2013 we examined 72 primary glaucoma patients (stage I-III), 44 women and 28 men, aged 49-87 years (65.2±2.5 years on average) referred by local ophthalmologists due to poor response to hypotensive therapy. RESULTS: We suggest that glaucoma should be regarded as resistant if, despite combination therapy with three antihypertensive drugs at optimal doses, IOP stays above the target. In the present study, the treatment was found suboptimal in 19.4% of cases. About 45% of all patients (33 patients) demonstrated poor compliance to the prescribed treatment. Resistant glaucoma, as we have defined it, was diagnosed in 33% of cases (pigmentary glaucoma, pseudoexfoliation glaucoma, secondary unrecognized glaucoma, etc.). This group also included patients, in whom b-blockers were initially effective, but then seemed to lose their power. CONCLUSION: 1. The reasons for intraocular pressure to resist hypotensive therapy are often associated with medical inertia (inaccurate diagnosis, inadequate treatment, etc.) and lack of patient compliance. 2. Resistant glaucoma in its true sense accounts for about 35% of cases of IOP being above the target despite conservative treatment. 3. It is advisable that at the time of first presentation, any patient who fails to reach the target IOP is treated as an «uncontrolled glaucoma¼ case, until the reasons for his/her resistance are clear.

[Temporary biokeratoprostheses in total destruction of the cornea].

The paper presents an original method for temporary biokeratoprothetics in total destruction of the cornea, which consists of the following. In the operating room a 12-mm disc is cut out of patient's conchal cartilage by a trephine and then thinned down to 1 mm with a blade. The prepared autograft is placed in front of the iris completely overlapping corneal defect and sutured to the sclera with 10--12 U-shaped interrupted stitches using a 7/0 suture. Between the stitches 0.2--0.3 ml of viscoelastic are injected into the anterior chamber. Temporary blepharorrhaphy is done within the temporal one-third of the eyelids with a U-shaped suture 6/0. The authors present an own clinical observation of patient D., aged 46, with purulent corneal ulcer and total destruction of the cornea. In ophthalmic emergency, if no donor cornea is available, the described method allows to save the eyeball from its anatomical and functional loss. Further routine keratoplasty or optical keratoprosthetics may bring some functional improvement.

[Experimental study on ocular hypotensive efficacy of parenteral metoprolol].

AIM: to evaluate ocular hypotensive efficacy of parenteral metoprolol in an experiment. MATERIAL AND METHODS: A total of 3 series of experiments on 24 rabbits were performed. The first series involved a single subconjunctival injection of 0.3 mg of metoprolol in the right eye, while the left served as a control. During the second series the rabbits received 0.5 mg of metoprolol intramuscularly. The third series also implied a subconjunctival injection of 0.3 mg of metoprolol in the right eye, however, supplemented with timolol 0.5% instilled in the left. In all rabbits tonometry was performed before the injection and then in 30 min, 1, 2, 3, 6, 8, and 24 hours. Biomicroscopy and ophthalmoscopy were also performed before and 1, 3, and 7 days after the injection. CONCLUSIONS: The maximum reduction (down to 30% from the baseline) of intraocular pressure (IOP) was registered in intramuscular metoprolol rabbits. Subconjunctival metoprolol was associated with a faster and more pronounced decrease in IOP as compared to timolol instillations. In case of local or systemic parenteral administration the hypotensive effect of metoprolol lasts for more than a day.

[Preservative-free betaxolol for POAG patients: evaluation of hypotensive effect and ocular surface safety].

AIM: To evaluate ocular surface changes in patients with primary open-angle glaucoma (POAG) as well as the hypotensive effect of preservative-free betaxolol eye drops. MATERIAL AND METHODS: A total of 22 patients (42 eyes) aged 55-83 with POAG stage I-II were examined. All of them were switched from betaxolol b.i.d. to its preservative-free analogue (Xonef BK). The baseline examination included visual acuity measurement, Morisky-Green test (questionnaire), Norn test, Schirmer's test, lissamine green staining, and ocular tonometry. The latter was repeated 2 and 4 weeks after the drug had been switched, while the whole complex--2 months after the beginning of the study. RESULTS: The total tear production in POAG patients under betaxolol therapy was 19.1 ± 10.6 mm. After the 2 months of preservative-free betaxolol use there were no statistically significant changes in Schirmer's test results (p = 0.248). Tear film break-up time (Norn test) improved from 7.8 ± 0.5 secto 9.8 ± 0.8 sec (p = 0.067) as well as the results of lissamine green staining (W = 90.0, p < 0.022). In the Morisky-Green Test betaxolol patients scored only 2.6 ± 0.05 points on average, thus showing non-compliance. After the 2 months of preservative-free betaxolol instillations the scores increased up to 3.1 ± 0.07 (p = 0.04). According to Dunnett's test, used for multiple comparisons, intraocular pressure did not change significantly in either of the study periods (baseline and follow-up measurements at weeks 2, 4, and 8 were taken into account). CONCLUSION: The study proves Xonef BK safe, effective, and appropriate in all types of glaucoma.

[Urgent therapeutic penetrating autokeratoplasty for a purulent corneal ulcer in the only functional eye].

The article presents a case of severe purulent corneal ulcer in the only functional eye of a young patient with Frank-Kamenetsky glaucoma and high-degree myopia. Combination therapy was ineffective and the patient developed a descemetocele. Due to the absence of cadaver corneas and small size of the only available conserved Alloplant cornea, the contralateral cornea (of the blind eye, which was enucleated under general anesthesia) was used for urgent therapeutic penetrating autokeratoplasty. Postoperative period was complicated with ocular hypertension, which was surgically resolved. To overcome the critical situation around keratoplasty, with results from Russian regulation gaps, the authors suggest creating interregional eye banks in large cities that would provide sampling, conservation and storage control of donor material in accordance with the existing legislation.

[Ophthalmic pathology in tubalars of the Altai Republic].

PURPOSE: To study the prevalence and structure of ophthalmic pathology in Tubalars, rural indigenes of the Altai Republic, for the benefit of the eye care system. MATERIAL AND METHODS: A total of 673 indigenes (67% of the whole population) aged from 1 month to 88 years, 521 Russians and 316 people of mixed parentage were examined. RESULTS: The general prevalence of eye diseases appeared to be higher in Russian newcomers (2481.75 per thousand) than in Tubalars (1965.82 per thousand), while the lowest proportion was found in the group of mixed parentage (1319.62 per thousand). The structure of ophthalmic pathology in Tubalars was as follows: refractive errors and accommodative disorders (799.40 per thousand), diseases of the conjunctiva (390.79 per thousand), retinal diseases (212.48 per thousand), lens diseases (164.93 per thousand), other ocular pathology and tumors of the auxiliary structures (124.81 per thousand), disorders of the lacrimal system (112.93 per thousand), corneal diseases (87.67 per thousand), strabismus (20.80 per thousand), congenital ocular anomalies (10.40 per thousand), glaucoma (8.91 per thousand), diseases of the vascular tract (8.91 per thousand), and eye injury (2.97 per thousand). CONCLUSION: The prevalence of eye diseases in the three ethnic groups proves interethnic differences. Tubalars demonstrated intermediate results between Russians (higher rates) and the group of mixed parentage (lower rates), which indicates unequal adaptation of these populations to harsh climatic conditions of the area. The obtained data are fundamental for informed management decision-making on rational distribution of health institutions and allocation of medical personnel and funds among the regions of the country.

[Retinal detachment in HIV-infected patients with cytomegalovirus retinitis].

The authors present their own clinical experience in three HIV-infected patients with cytomegalovirus retinitis aged from 8 to 36 years. Detailed analysis of the results of physical and laboratory examinations is provided. Given short life expectancy for these patients, the authors pose a deontological question as to whether or not active treatment of retinal detachment in patients with AIDS and CMV retinitis is reasonable.

[Life expectancy of patients with primary glaucoma, residents of a large industrial city of Siberia].

PURPOSE: To investigate life expectancy and the structure of causes of death in patients with primary glaucoma, residents of a large industrial city of Siberia. MATERIAL AND METHODS: The database of the Novokuznetsk Public Health Department information analysis center on registration forms 025 (outpatients) and 066 (inpatients) for 2004-2011 was analyzed. RESULTS: A total of 5424 primary glaucoma patients were registered during 2004-2011, of whom 441 (8.1%) subsequently died. Age at death of patients with primary glaucoma was 69.0 +/- 7.2 years. The difference between age at death and at diagnosis of glaucoma was 2.6 +/- 1.8 years. CONCLUSION: The correlation suggests that primary glaucoma is a predicting factor for vascular events, such as stroke or myocardial infarction. The authors assume that topical administration of beta blockers without consulting a physician and/or a cardiologist may lead to ischemic stroke.

[Regarding the method of the total tear production assessment].

Different Schirmer test I techniques presented in the literature have been reviewed and a comparative study of Schirmer test I results obtained with the eyes opened and closed has been conducted. The total tear production with the eyes opened vs. closed averaged 17.1+/-1.1 mm and 12-1.2 correspondingly (p=0.001; Mann-Whitney U test). In 22% of patients values were higher with the eyes closed rather than opened. The authors recommend to specify the conditions of the performed test when entering the results into the patient's chart.

[Incidence, structure and features of eye diseases in steelworkers].

Incidence and structure of eye diseases was studied in workers of Novokouznetsk Steelworks who have occupational hazards. High incidence of inflammatory and dystrophic diseases of eyelids and conjunctiva as well as cataract was revealed in steelworkers. The incidence of eye diseases was showed to rise with the increase of work period in hazardous environment.

[Study on causes of ophthalmologists' inertia in glaucoma treatment].

The problem of inertia in ophthalmological practice, which implies the absence of any adjustment of the given treatment, even if an adjustment is objectively necessary or clinically indicated, was studied. According to the authors, the problem is most pressing when multifactorial diseases, including primary glaucoma, are concerned. An anonymous survey of 147 ophthalmologists from different West Siberian regions (Altai Krai, Kemerovo region, and Republic of Khakassia) was conducted. The set of causes for ophthalmologists' inertia was identified. The leading cause appeared to be psychological reluctance to achieve target intraocular pressure and overestimation of therapeutic success. Other causes, although less significant, include lack of professional awareness and economic barriers to decision making.

[Population-based study of tear production in healthy individuals and patients with dry eye syndrome in Altai Republic].

For the first time population-based study of tear production was performed, prevalence and risk factors of dry eye syndrome (DES) were determined in native ethnic group of Altai Republic--tubalars. Authors examined 673 people, representing 44% of the whole tubalar population. The mean total tear production (Shirmer test I) was 13,3 +/- 0,3 mm in healthy (without DES signs) tubalars. It ranges in 22,6% of healthy tubalars from 0 to 5 mm, in 20,8%--6 to 11 mm, in 20,5%--12 to 17 mm, in 34,5%-- > 17 mm. Prevalence of DES in tubalar population is 86,18 per thousand. Total tear production (Shirmer test I) in tubalars with DES ranges from 0 to 5 mm in 34%, 6-11 mm in 31,5%, 12-17 mm in 21% and > 17 mm in 13% of eyes. This results showed Shirmer test I to be nonspecific in diagnosis of DES. In author's opinion this test may be useful for follow-up and for assessment of treatment efficacy.

[The value of neopterin in etiological diagnosis of endogenous uveitis].

Neopterin concentration in blood serum and tear fluid was estimated in 94 patients with endogenous uveitis and 28 healthy subjects. Neopterin concentration was found to be elevated in blood serum of patients with herpetic (12,31+1,1 micromol/L), tubercular uveitis (17,77+4,18 18 micromol/L) and uveitis associated with systemic conditions (12,31+1,1 micromol/L). Neopterin concentration in blood serum of healthy subjects was 8,45+0,61 micromol/L. Dynamics of neopterin concentration in blood serum of patients with uveitis varies depending on etiology. Neopterin concentration in tear fluid of healthy subjects appeared to be higher as compared with blood serum and was as high as 14,52+1,61 micromol/L (p < 0.05). Due to wide range of neopterin concentration in tear fluid, absence of significant correlation with blood serum concentration, apparently because of additional "local" production, authors propose to use only blood serum neopterin concentration for etiologocal diagnosis and control of treatment efficacy.

[Plasmapheresis combined with cell mass ozonation in endogenous uveitis treatment].

Authors propose a new method of uveitis treatment based on plasmapheresis in combination with cell mass ozonation. Analysis of treatment results of 3 patient groups (179 patients, 209 eyes) showed advantage of this original modification of plasmapheresis. In our opinion the effectiveness of proposed treatment option is associated with immunomodulatory effect of plasmapheresis and ozone therapy as well as bactericidal, antiviral and fungicidal effects of ozone therapy. Some sanogenetic mechanisms of the new treatment are disclosed in the study such as correction of T-cell immunodeficiency, decrease of circulating immune complexes and others.

[Comparative characteristics of the gene pool of Teleuts inferred from Y-chromosomal marker data].

The gene pool structure of Teleuts was examined and Y-chromosomal haplogroups composition and frequencies were determined. In the gene pool of Teleuts, five haplogroups, C3xM77, N3a, R1b*, R1b3, and R1a1, were identified. Evaluation of the genetic differentiation of the samples examined using analysis of molecular variance (AMOVA) with two marker systems (frequencies of haplogroups and Y-chromosomal microsatellite haplotypes) showed that Bachat Teleuts were equally distant from Southern and Northern Altaians. In Siberian populations, the frequencies and molecular phylogeny of the YSTR haplotypes within Y-chromosomal haplogroup R1a1 were examined. It was demonstrated that Teleuts and Southern Altaians had very close and overlapping profiles of R1a1 haplotypes. Population cluster analysis of the R1a1 YSTR haplotypes showed that Teleuts and Southern Altaians were closer to one another than to all remaining Siberian ethnic groups. Phylogenetic analysis of N3a haplotypes suggested specificity of Teleut haplotypes and their closeness to those of Tomsk Tatars. Teleuts were characterized by extremely high frequency of haplogroup R1b*, distinguished for highly specific profile of YSTR haplotypes and high haplotype diversity. The results of the comparative analysis suggested that the gene pool of Bachat Teleuts was formed on the basis of at least two heterogeneous genetic components, probably associated with ancient Turkic and Samoyedic ethnic components.